New M-CHAT Scoring Guidelines

Posted By - HMG

A recent study by the M-CHAT developers, published in the March 2013 issue of Pediatrics, has resulted in new scoring guidelines for the M-CHAT. Below are highlights from the study, compiled by First 5 Alameda County, an HMG affiliate.

Background and Study Results

  • The M-CHAT developers used the M-CHAT and M-CHAT Follow-Up Interview (which they are now calling the M-CHAT-F) to screen 18,989 toddlers at pediatric well-child visits in two areas of the US.
  • The developers have clarified guidelines for using the M-CHAT/F to improve predictive validity. 
  • The M-CHAT (along with the M-CHAT/F) continues to be a powerful tool to identify children with significant concerns.
  • Results: Fully 98% of the children who screened positive on the M-CHAT and M-CHAT/F had a diagnosable disorder or developmental concerns requiring a referral to early intervention (54% of those children were diagnosed with autism).

Quick Scoring Highlights from the Study 

  • The critical question designation on the M-CHAT has been eliminated. According to the study and in a follow up email I had with Diana Robins (one of the M-CHAT developers), the critical score does not improve the performance of the tool and the developers’ data “suggests that the total score is the best way to assess risk.” Any child with a total score of 3 or more needs follow-up.
  • The developers are recommending different follow up procedures for children who score between 3 and 6 and children who score 7 or more on the M-CHAT:
  • For children who score between 3 and 6 on the M-CHAT, the M-CHAT/F should be administered.
  • For children who score 7 or more on the M-CHAT, the child can be referred directly for evaluation. For children with this score, the M-CHAT/F is not necessary.
  • What stays the same?
  • It is still recommended that the M-CHAT is used at either the 18 or 24 month well-child visit.
  • Providers can refer any child they wish to the Linkage Line for follow-up. (No matter what the M-CHAT score is)
  • Help Me Grow Linkage Line staff are able to conduct the M-CHAT/F interviews with families.
     

What changes for providers?

  • When scoring the M-CHAT, score without special attention to the critical questions.
  • When a child scores 3+, it is recommended that the provider conduct the M-CHAT/F interview as part of their referral decision.
  • When a child score 7+, the provider can be assured that the child needs an evaluation and can refer accordingly (to HMG or the Regional Center).
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